From: Ethnographic process evaluation in primary care: explaining the complexity of implementation
 | Method | Previous research | Innovation | Detail |
---|---|---|---|---|
Used to discover key themes and patterns | Site Coordinators (SCs) | - Hired from outside the organization | - Hired from within the organization | Nurses and quality improvement specialists, 2.5 FTE between 4 SCs; training in interview methodology + ongoing informal methods training |
- Assist with implementation (practice facilitation) | - Play an essential role in data collection, analysis/interpretation (as well as practice facilitation) | |||
Diary entries completed by SCs | - Structured format with set open-ended questions | - Unstructured format, no set questions | Submitted weekly; email reminders; qualitative lead collates each month’s entries by site, inserts questions & comments & returns to SC for clarification; relevant practices and ideas shared with team | |
- Rolled out with no training | - Training that emphasizes rich description and the value of the diarists’ own knowledge and insight | |||
- One way flow of information from diarist to researcher | - Feedback loops between diarist and researcher regarding diary content | |||
ECCO (Episodic Communication Channels in Organization) surveys | - Measure spread of multiple messages to capture communication channels in a given organization | - Snapshot of success of communication strategies by role related to a single intervention | Anonymous 2-page paper survey conducted 1Â year post-implementation at 5 clinics; completed by 64 individuals (15 PCPs*, 12 RNs**, 17 MAs***, 20 other (pharmacy, panel managers, etc.) | |
Document review | - Collect relevant clinic documents to gain insight into organizational culture and context | - Same; also collect relevant email communications to document team interactions within and across organizations | SCs forward clinic documents to qualitative team, with explanations placing them in context. As of study year 4, have 191 such documents. | |
Observation | - Observation of clinical workflow | - Same; also view team meetings as ethnographic encounters worthy of study | Informal observation in clinics and at team meetings throughout study; formal half day shadowing of 1–2 clinicians per clinic. Study year 3 & 4. | |
Used to challenge or corroborate findings; fill in detail | Group Discussion | - Scheduled as stand-alone discussions with pre-selected participants | - Integrated into regular clinic meetings | 1-2 group discussions per clinic, with PCPs, RNs, MAs and panel managers (divided by role); Discussions last 0.5-1 hr; Recorded & transcribed. Study years 3–5. |
 |  | - Emphasis on confidentiality; no clinic leadership present | - Usually co-conducted with clinic leadership |  |
 |  | - Principal method of data collection | - Used to fill in knowledge gaps and test researcher understandings |  |
 | Interviews | - Conducted by single outside researcher | - Co-conducted by outside researcher and site coordinator | 4-6 interviews per clinic |
 |  |  |  | (2–3 PCPs, 0–1 RNs, 0-2 management) Recorded & transcribed. Study years 3–5. |
 |  | - 0.5-1 hr in length | - 20 mins in length (1 patient encounter) |  |
 |  | - Principal method of data collection | - Used to fill in knowledge gaps and test researcher understandings |  |
Human subjects protection | Informed consent | - Signed | - Verbal | Ethics board considered the process evaluation low risk. |